Individual
MICHAEL CHARLES BUBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
826 ALDER ST, SOUTH BEND, WA 98586-4900
(360) 875-5579
(360) 875-5235
Mailing address
PO BOX 269, SOUTH BEND, WA 98586-0269
(360) 875-5579
(360) 875-5235
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OP00001152
WA
207QG0300X
Geriatric Medicine (Family Medicine) Physician
OP00001152
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049602
LABOR&INDUSTRY-BUBEN
WA
05
—
1035732
—
WA
01
—
11143410
CAQH
WA
05
—
7093644
—
WA
05
—
7125362
—
WA
Enumeration date
06/16/2006
Last updated
03/23/2015
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